Medicaid reform bill draws opposition from those it would serve

Updated 10:11 pm, Tuesday, February 26, 2013

AUSTIN - State legislators Tuesday began debating a Medic­aid reform bill intended to improve and expand care for those with long-term disabilities but drawing opposition from some individuals the change would affect.

The Senate Health and Human Services Committee heard hours of divided testimony about the legislation, which would enlist managed care organizations to coordinate care that now is often fragmented. The bill would curb Medicaid costs, though proponents said that is not the point of the bill.

"This is a major bill and a major change," said Sen. Jane Nelson, R-Flower Mound, who chairs the committee and sponsored the legislation. "We want to provide the best service we can to the most people in need, but we can't do it unless something changes."

Nelson said her office has received more than 150 pieces of correspondence about the bill since last week, and she took the unusual step of setting up a meeting during an hourlong break, before public testimony, at which key state staffers attempted to dispel "misconceptions" of opponents.

The bill would expand managed care dramatically over a seven-year period, including in nursing homes; establish pilot programs to test providing services at a set cost; and direct HHSC to develop payment systems based on the quality of careaimed at reducing preventable errors and improving outcomes in the Medicaid long-term care system.

The committee is to vote on the bill Wednesday. If passed, it would go to the Senate floor.

Medicaid spending for the acute and long-term care of Texans with physical and intellectual disabilities exceeds $16 billion annually, according to the Texas Health and Human Services Commission. That constitutes 58 percent of Medicaid dollars, even though only 25 percent of Medicaid beneficiaries fit either of those categories.

Roughly 160,000 children qualify for the Medic­aid program as a result of a significant physical or intellectual disability, said a Texas Children's Hospital doctor.

Lengthy waiting lists

Nelson and HHSC Deputy Commissioner Chris Traylor, who testified at the hearing, said the problem with disability care now is the interminable waiting lists for services, sometimes as long as 10 years. Under the bill, benefits would be expanded to 12,000 more people by Sept. 1.

It calls for all Medicaid beneficiaries to be covered by a managed-care organization by 2020.

The legislation largely was supported at the hearing by disability care advocacy groups and leaders, but its expansion of managed care clearly frightened individuals, particularly parents of children with intellectual disabilities.

"If you make budget cuts, it's going to take away from a very fragile ecosystem that takes care of these people," said Susan Johnson, an Austin mother of a 27-year-old with an intellectual disability. "Communities give to these people. They won't want to give to managed care."

She said she would support the bill if lawmakers put in writing that its administrative costs will not affect provider services.